| NPI | 1962649012 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL C FIDGEON COO 540-710-6085 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 158 05 001) |
| Enumeration Date | 2009-01-12 |
| Last Update Date | 2009-01-12 |